Addressing BPD in the Classroom: Quickstart Guide

Hey there everybody, and welcome to this presentation on managing Borderline Personality Disorder in the classroom. This is a quick start guide and I'm your host, Dr. Donnellice Snipes. There are a lot of reasons that problems may be triggered in the classroom for people with borderline Personality disorder. The first one surrounds fears of abandonment or rejection. And there's a lot of reasons for that category. Kids can be mean. Let's just face it. When people are younger, if you think back to high school, they hadn't developed necessarily tact in the way they say things. There could have been, you know, unkind words said. So peers can be a direct cause of anxiety and stress in the classroom. That can trigger emotional dysregulation in people with bpd. Academics can also trigger fears of abandonment or rejection. If someone is not doing well in a class, they may feel like they are a failure instead of they're failing at algebra. But either way, they may emotionally dysregulate because they are afraid of being held back, they're afraid of flunking out, they're afraid of rejection or ridicule. They're so from a teacher standpoint, it's really important to make sure that if you have a student that is struggling academically that they are provided with support and encouragement. And if they are known to emotionally dysregulate when they get a bad grade, it's really important to handle that carefully. When you're handing back exams, for example, if they failed the exam, you don't want to just hand it to them and say do better next time, that is probably going to trigger a lot of anxiety. So maybe giving them their paper or their exam back in private so you can discuss it with them and help them process what's going on. And finally, projection, good old projection, can cause an upsurgence of emotional dis, disregulation and BPD type symptoms in the classroom. If there is someone in the classroom that reminds them, and it could even be you, the teacher, that reminds them of somebody in their past who has rejected them, then that may trigger some tension in the person and with the person with borderline personality. Now, it doesn't mean that these are insurmountable. What's important is to help the child be aware of their triggers and vulnerabilities so they can address them. Interventions, acceptance, working with the child to develop mindfulness and acceptance. And that is really hard. That's not just, you know, just accept it is what it is. That is way easier said than done. But we also need to accept children for who they are and how they are in the moment. If they are dysregulating, not judging them, but accepting that they are feeling out of control in the moment. And that is really important. Instead of rejecting or criticizing or minimizing them, accepting and validating how they feel so they feel like they've got a support, create safe spaces. This is somewhere where a person with borderline personality or who's dysregulating can go. Where they don't have any more input, where they don't have eyes peering at them because they are, you know, crying hysterically or they're really angry. Where can they go to to get back into their wise mind, to re regulate, to urge, surf until they can get into their wise mind. And mindfulness and grounding are also very important. Helping youth focus on where they are in context, that they're safe in the moment, identifying what's going on around them that may be triggering and what they can do to best improve the moment. And a lot of these things that I'm saying hearken back to a lot of what Linehan talks about in dbt. Emotional dysregulation is another issue in the classroom. And when people with BPD or BPD type symptoms feel a fear of rejection or start to feel anxious or angry or threatened or unsafe, or they may dysregulate. And there are a lot of vulnerabilities. If the youth is not sleeping well, if they're in pain, if they're sick, if, you know, the list goes on, that can make them more vulnerable to dysregulation. I mean, think about it for yourself. On days when you don't feel well or you're overtired, sometimes you react to things more strongly than you would on days when you're well rested. Affective vulnerabilities. Well, being teenagers, there's generally a lot of affective angst going on. Their hormones are going all over the place. Developmentally, they're going through so many different things. So there can be a lot of periods of anxiety, anger, depression, and sometimes they may feel all of them all at once. And it can feel very overwhelming, which can put them in a position where any other input could trigger dysregulation. Kind of like a pressure cooker, you know, they are at max pressure and any more heat could blow the top off. Cognitive vulnerabilities, you know, are they having negative thoughts? Are they engaging in catastrophic thinking? Well, that can set them up for dysregulation. If they are thinking in global all or nothing terms. Environmental vulnerabilities. Sometimes lights, smells, sounds, distractions, or even particular people in the room could trigger emotional dysregulation. It could add stress to their existence, which means they are more vulnerable to dysregulating when additional stress happens. And relational vulnerabilities. You know, adolescence is a time where there are a lot of relationship challenges, forming friendships and intimate relationships. So if something like that is happening, obviously it's not something that's related directly to what's going on in the classroom. But your student who just broke up with their boyfriend or got into a fight with their best friend may be more emotionally vulnerable when they're in class. So something like failing a test or getting called on and feeling like they are, you know, the center of everybody's attention, feeling like they're on the spot, could be enough to dysregulate them. Interventions here, mindfulness, again, helping them develop a sense of where they are, being mindful of what's going on in the moment. Grounding. And I'm going to share with you some posters, some suggestions for things to post on the wall to remind students of some of these skills. Distress tolerance skills. It doesn't mean getting rid of the distress. Distress tolerance skills helps help people be able to sit with the stress, to urge surf to know that this discomfort will go away after a little while. And breathing, that slow breathing that helps trigger the rest and digest. Another issue that can become an issue in the classroom for people with BPD is all or nothing thinking. Remember when that HPA axis, that threat response system is triggered, a lot of times the person gets tunnel vision and they have a hard time seeing all of the options. They're just focused on getting away from the threat. Helping students at this point figure out what they need to do to get into their wise mind and embrace the dialectics. Okay, you know, you failed the test and you have three more opportunities to, you know, three more tests that will raise that grade. So all is not lost. Basically embracing the good with, you know, the unpleasant cognitive distortions, paying attention to the way the person is thinking that all or none thinking and challenging it with exceptions. You're saying this happens all the time. Can you tell me, give me an example of one time when it didn't happen this way. Like every time I take a math test, I fail. Well, let's think about that. Is that actually true? Which goes to facts. We want to look at the facts. It may feel like every time you take a math test, you fail, but let's look at the facts and Are there alternate explanations for things? Sometimes we assume things or we use generalized terms when in, in actuality, there are other alternate explanations. Maybe the test questions were unusually hard. It wasn't that the person, you know, did worse than usual. It was that the test was harder than usual. And finally, impulsivity is another problematic behavior of people with borderline personality issues in the classroom. And a lot of times people react impulsively as a way to try to stop that pain. They are feeling out of control. And the one thing that they can control is sometimes their, their pain levels. You know, they can engage in, in cutting or other impulsive behaviors, but sometimes that impulsive behavior is just a reaction to the threat. You know, the get out, get me away, keep me safe. So ultimately, impulsivity is designed to keep the person safe. And the best way to handle this, ideally is through prevention. So what does all that mean? Well, first, recognize that these behaviors help the child survive trauma. They develop for a reason. The whys are less important in the classroom as understanding the triggers and possible interventions. Why Jiminy developed this behavior is less concerning to the teacher as what are her triggers and what possible interventions can I use? School counselors can work with the child to develop a list of triggers, their vulnerabilities, and effective interventions. What triggers that child? What makes that child more vulnerable to dysregulating? And what are some effective interventions for that child? And empowering the child to participate in this process is crucial. Teachers can help prompt mindfulness and the use of identified interventions in class. If you notice that the student is starting to look stressed, is starting to spiral, so to speak, then teachers may have a cue that they use, like coming over and tapping the person on the shoulder or, you know, something that is not really noticeable to the rest of the class that can remind the person to engage in mindfulness type activities. And finally, post Mindfulness Vulnerability awareness and distress tolerance posters in the classroom. This is an example of a mindfulness poster reminding people that they can focus on noticing five things they see, four things they hear, three things they smell, two things that help them feel safe right now, and one way they can improve the moment distress tolerance skills. This is one of the mnemonic devices developed by Linehan. And this is accepts actions, comparisons, contributions, emotions, pushing away unpleasant thoughts, having positive thoughts and strong sensations. And this particular poster gives examples of each one of those. And finally, vulnerabilities. Remembering that vulnerabilities come in many different shapes and sizes, encouraging people to check in with themselves and notice physically, are they hungry, in pain, Tired, sick, something else, physical causing stress that can make them more vulnerable to react more strongly to situations. Emotionally, what current emotions are causing them stress? You know, what do they already have going on that is putting pressure in that pressure cooker? That may mean that additional stress could result in dysregulation. Environmentally, what sounds, smells, sights, or even just energy in the room might be triggering stress. You know, right before a exam, there might be a lot of stress in the room and that the energy in the room is palpable of everybody being stressed about the test. And that can be triggering for people and interpersonally, what people or relationships are causing stress for the person at that point in time. And it may not be like somebody that's sitting right there. It may be, as I said earlier, that they had a fight with their best friend, you know, at lunch, and it's still causing them a lot of distress. Recognizing that is important. Recognizing that that is adding pressure to their pressure cooker and making them more vulnerable to dysregulation is really important. Encourage students, if you can, take two minutes before the start of each class and encourage students to reflect on how are you feeling, what vulnerabilities do you currently have and what is one thing you can do to help you have the best class possible. You notice I chose my words very carefully on that last one because you don't want to say, what, what are the best thing, what is one thing you can do to help you feel better? Because one of the things they may say is, well, go home. Well, that's not an option. So what is one thing you can do to help you have the best class possible? More in depth videos can be found on the DBT skills playlist at allceus.com dbt list.